“The pursuit of knowledge about human beings has never been work for me; it has always been pleasing … When you finally get down to it and want to learn that the beginnings of the human being—the replication of his cells, the protoplasmic determination, and the things that make them wrong or natural—constitute a fascinating road to follow … That kind of interest led to the study of medicine. Following that came the decision on how best to personally do something about it. That meant surgery as a specialty. This led to cancer and uncontrolled cell replications … I learn something about this phase of the human being on a daily basis. And this is why every day is a good day …”

-- Randolph Lee Clark Jr1

While Dr Randolph Lee Clark Jr is well-known historically as the first Director2;Footnote 1 and Surgeon-in-Chief of the University of Texas MD Anderson Cancer Center, little has been written about his prodigious and extensive activities as a general surgeon and as a surgical oncologist. His professional activity is also a story of general surgical practice in the 1940s and 1950s, a time when there was very little surgical specialization, limited availability of antibiotics, and few options for cancer treatments other than surgical excision.

We are fortunate, historically, that Lee Clark was a prolific writer and that he frequently chronicled his activity in typewritten letters to family, friends, and surgical colleagues. This is the previously untold story of his surgical activities, including involvement in many surgical societies.

Early History (1907–1928)

Randolph Lee Clark Jr was born on 2 July 1907 in Hereford, TX, where his parents had moved to help his grandfather to start another school,1,2;Footnote 2 He grew up in Wichita Falls, TX, where his father, Randolph Lee Clark Sr, was Superintendent of Schools.1;Footnote 3,Footnote 4 After graduating from high school at age 16 (in 1923), he went to Tarleton Junior State College and then transferred to the University of South Carolina, where he received a Bachelor of Science degree in Chemical Engineering, including a major in English literature, in 1927.1,3,4 With only $5 in his pocket at graduation, he had to earn money for medical school. He then worked for 18 months at a major chemical firm in Newark, NJ, where he supervised a research unit that included 14 PhD chemists. He invented a new process for making a pigment that for years was used in the manufacture of paint and tires.4,5,–6 He later recalled: “Research and chemical engineering were satisfying, but they dealt with inanimate objects … I hoped I would find in the study of medicine what I had been looking for all along, the meaning of life and people”.1 In September 1928, Lee Clark and his boss (and future brother-in-law), Jack Worsham, left their job at the chemical plant and drove to Richmond, VA, to attend the Medical College of Virginia (MCV).4

Surgical Training (1932–1939)

Dr Clark received his medical degree from the Medical College of Virginia in 1932, where he ranked first in his class7,8 (Fig. 1 and electronic supplementary Fig. S1) (see footnote 4). Dr J. Shelton Horsley, Surgeon-in-Chief at MCV, sparked his interest in cancer surgery.1,9 One week after graduating, he married Bertha Margaret Davis (on 11 June 1932), who was the only woman in his medical school class and who graduated second in the same class (Fig. 1c).1,10 Drs. Lee and Bertha Clark took their state medical board examinations while on their honeymoon, then they both did a rotating internship at Garfield Memorial Hospital in Washington DC from July 1932 to December 1933.1,4

Fig. 1
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(a) Medical students Lee Clark and Bertha Davis at their anatomy class at the Medical College of Virginia (1930). Graduation photos of (b) Dr R. Lee Clark Jr and (c) Dr Bertha Margaret Davis in June 1932. (Photos courtesy of McGovern Historical Library, Texas Medical Center. Series I. Box 44; file 14 and Box 28; file 19. Used with permission)

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It was common at that time for surgeons to have part of their training in Europe. Therefore, Drs Lee and Bertha Clark went to Paris, where he trained as a surgical resident at the renowned American Hospital from December 1933 to January 1935 (the only private hospital in Paris) and his wife trained as an obstetrical residency at Tarnier Maternity Hospital (Fig. 2).1,6 In his second year as a surgical resident, he worked for 6 months at the Pasteur Institute and the Radium Institute under Marie Curie, the twice Nobel Prize winner, during her final months of life. As one of the leading centers in the world, the Radium Institute experience showed Dr Lee Clark the potential of using brachytherapy and external-beam irradiation for future cancer treatments.1,4 This experience early in his career surely influenced him when he arrived in Houston as the Director and Surgeon-in-Chief of MD Anderson Hospital, where one of his first major recruitments was Dr Gilbert Fletcher as Chief of ‘Therapeutic Radiology’, who established the world’s first cobalt 60 radiation unit.1,4 During his residency in Paris, he worked with the famous Dr Thierry de Martel, the Director of the American Hospital and founder of French neurosurgery; this was an important experience as a surgical trainee, for Dr Clark would years later be the only surgeon in Mississippi who would perform neurosurgical procedures in the brain and spine. During his last few months in France in 1935, Dr Clark traveled to Strasbourg to visit the famous surgeon Henri Reni Leriche. While at the Clinique Chirurgicale, he met an American surgeon who had just arrived for training, Dr Michael E. DeBakey from New Orleans.11 The two of them would join together 13 years later in Houston as surgical leaders in the Texas Medical Center.

Fig. 2
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Dr Clark had his early surgical training at the famed American Hospital in Paris from 1933 to 1935. His wife, Dr Bertha Davis Clark, trained as an obstetrical resident at the nearby Tarnier Maternity Hospital. Photo at the hospital includes (left to right) Drs. Duncan McEachern, Lee Clark, Bertha Davis, and William Farmer. (Photo courtesy of McGovern Historical Library, Texas Medical Center. Series I. Box 28; file 19. Used with permission)

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Fate would influence his surgical career when Dr Claude Dixon, Head of General Surgery at the Mayo Clinic, visited the Salpetriere Hospital in Paris in 1934.12 Dr Clark then invited him to tour the American Hospital, where he was the Chief Resident in Surgery (Fig. 3a).1,12;Footnote 5 From that time forward, Dr Dixon became his primary mentor throughout his career, first encouraging him to come to Mayo Clinic for training (April 1935–October 1939), then advising him regularly about his general surgery practice in Jackson, MS (1939–1942), and later being a primary advocate for him being appointed as the Director and Surgeon-in-Chief of the MD Anderson Cancer Hospital (1945–1946).

Fig. 3
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(a) 1957 photo of Dr Claude Dixon (1893–1968) who was Chief of General Surgery during Dr Clark’s training, and an expert in colorectal surgery at the Mayo Clinic, Rochester, MN. He was a primary mentor to Dr Clark over his entire career.12 (b) 1952 photo of Dr O.T. (Jim) Clagett (1908–1990) who trained with Dr Clark at the Mayo Clinic in the 1930s. He became the Chief of Thoracic Surgery in 1940 at Mayo Clinic. Dr Clark considered him as one of his best friends.1 (Photos Courtesy of Mayo Clinic. Used with permission)

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At the Mayo Clinic, Dr Clark did not begin as a surgical trainee, but instead spent the first 15 months training in internal medicine and then as a surgical resident for 3 years (electronic supplementary Fig. S2).2,4 This dual training experience uniquely shaped his cancer practice into a blend of both a surgical and medical perspective. His general surgery surgical experience was prodigious and extensive, having been involved in 2000 operations at the Mayo Clinic; cancer cases comprised about two-thirds of this caseload.1 He was the first assistant for 18 months with his surgical mentor, Dr Claude Dixon, who was Chief of General Surgery (Fig. 3a and electronic supplementary Fig. S3). He also earned a Masters of Science in Surgery from the University of Minnesota in 1938 with a thesis of ‘Iron Metabolism and Anemia with Cancer of the Right Colon.’13 His wife Bertha was offered a staff position in pediatrics at Mayo Clinic, but instead she chose to train in anesthesia (and gave birth to their two children while in Rochester) [electronic supplementary Fig. S2].1

Dr Clark’s mentors thought highly of his professional skills. Dr Claude Dixon, his primary surgical mentor at Mayo Clinic, stated that Dr Clark was “one of the most outstanding young men we have ever trained. He also is one of the very few men who is both an excellent clinician and an outstanding surgeon, and who at the same time has maintained a keen interest in research”.14 “I do not have the slightest doubt”, wrote Dr Dixon in 1946, “but that he will develop into one of the great leaders in the profession”.15 Dr Albert C. Broders, Director of Surgical Pathology (August 1939), stated, “Dr Clark is one of those rare individuals in whom is combined imagination, sound judgment, energy, technical skill, and integrity which is at all times above reproach”.16 Even the legendary Dr Will Mayo was interested in recruiting him onto the Mayo Clinic surgical staff at the completion of his surgical training.15

Surgical Practice in Jackson, MS (1939–1942)

Once again, fate would offer a unique opportunity for Dr Clark to fully utilize his surgical skills in Jackson, MS, where he would be the Chief Surgeon in a private clinic with three surgical partners.1 This practice opportunity, which drew from a large geographic area with 70 primary physicians, came about because one of their senior surgical partners (Dr Frank Hagaman) tragically died in an auto accidentFootnote 6 and the practice needed an immediate recruitment.17 However, there were also personal reasons. Dr Clark’s brother-in-law, Dr John Henthorne, had already moved to Jackson, MS, from the Mayo Clinic as a pathologist at Mississippi Baptist Hospital. This family relationship influenced the Clark family’s decision to settle in Jackson, MS.1 Interestingly, he also wanted his family to be raised near his Texas roots. When asked why he and his wife had not stayed at the Mayo Clinic, he responded: “I have been in Jackson two years … I could not see myself remaining in Rochester and raising my kids as Yankees, so we moved before they developed an accent”.18

Beginning in October 1939, Dr Clark quickly developed a prodigious surgical practice at Mississippi Baptist Hospital, with his wife Bertha (Bert) as his primary anesthesiologist. Cancer surgery comprised the majority of his caseload, as it had at the Mayo Clinic. As Dr Clark described his surgical practice, “Since my arrival here, we have had over a thousand surgical cases to do. There is an abundance of pathology in these parts, and I have recently had quite a few neurosurgical cases”.19 His general surgery practice was huge and comprehensive (Table 1). He described his practice in 1942 in two letters. The first was when he applied for his commission in the Air Division of the Army Medical Corp: “I have done a large volume of surgery in private practice since I left the Mayo Clinic nearly 3 years ago, having done more than 600 major operations a year, of all types—from the brain to the colon”.20 After receiving his commission, he wrote to his surgical mentor, Dr Claude Dixon, at the Mayo Clinic: “I am enclosing a list of patients I had in the hospital on the day I received my (Army) Commission. All of these patients were on my personal service, and I had operated upon them personally, and, as you will see, there is considerable variety. I have been very pleased all along with the great amount of pathology that I have seen since working in Mississippi ... We had no mortality on this list. I must admit, however, that this was the biggest list to date, though I have consistently had over 25 postoperative patients in the hospital for the past year and a half”. 21 Years later, he described his Jackson surgical practice: “We were there two years, and I did over 1000 major operations, of which a disproportionate number were cancers or tumors”.1 His wife Bertha was equally herculean in her work ethic, having performed over 1400 anesthesia procedures during the same 2-year time period. 6

Table 1 A typical 9 weeks of surgeries by Dr Clark in 1942a
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Dr Clark was a diligent student of surgery and was constantly adopting new surgical procedures. The mentors for his surgical practice were three surgical icons, with whom he frequently corresponded: Drs. Claude Dixon and O.T. (Jim) Clagett at the Mayo Clinic (Fig. 3), and Dr Alton Ochsner at Tulane University Medical Center and the Ochsner Clinic (Fig. 4a). He wrote many letters to these three surgeons for advice and traveled on multiple occasions to observe surgery at the Mayo Clinic and the Ochsner Clinic.22,23,24,25,–26 As described in one of his letters: “Bert (and I) came up to the (Mayo) Clinic for about a week. We had a good time and learned a lot of new tricks. I was particularly interested in the neurosurgery, and it will probably be necessary for me to do a good bit of it”.25 In a letter Dr Clark wrote to Dr Ochsner: “I wish to tell you how much I enjoyed attending your surgical clinic and observing you operate … I would appreciate it if, at your convenience, you would let me know on what days I would most likely to find you having an operative clinic”.26 Dr Ochsner replied a few days later: “It was indeed a pleasure having you several weeks ago. I only regret that you could you not have spent more time with us … I hold my operative clinic on Tuesday, Dr Gage has his on Thursday, and Dr DeBakeyFootnote 7 has his on Saturday”27,28 (Fig. 4b).

Fig. 4
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Dr Alton Ochsner (1896–1981) and Dr Michael DeBakey (1908–2008) at the Ochsner Clinic and Tulane University Department of Surgery. Dr Ochsner was the Founder of the Ochsner Clinic in New Orleans, LA, and President of the American College of Surgeons (1951–1952). Dr Ochsner was a mentor to both Dr Clark and Dr DeBakey and encouraged both of them to take the professional risk of starting major programs in the 1940s at the newly formed Texas Medical Center, Houston, TX.

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The American Board of Surgery began a national two-part examination program in 1938 to standardize surgical education and assess expertise. Surgeons were expected to be ‘Board Certified’ after completion of surgical training plus 2 years of surgical practice.29 Therefore, in January 1942, Dr Clark applied to take the American Board of Surgery examination. As required, he listed his caseload of 820 operations at Mississippi Baptist Hospital, including 411 ‘colonic surgeries’, with 43 deaths (10.46% mortality) and 409 cases listed as ‘others’,Footnote 8 with eight deaths (1.9%), for a total mortality rate of 6.2%.30 The most common causes of postoperative deaths were peritonitis (14 patients), sepsis (7), intestinal obstruction (7), embolus (6), and pneumonia (5). These outcomes are truly remarkable, given the diversity of caseload in every anatomic area, and that he was the only surgeon between New Orleans and Memphis who was performing these large-scale operations, at a time when there were only sulfa antibiotics to treat any surgical infections.

In March 1942, Dr Clark paid $20 to take the written examination (Part I) of the Surgical Boards (which he passed), and was then quickly scheduled for the oral examination (Part II) the following month.31 He paid $50 for this second examination and then traveled to New Orleans to take the Board examination on 20 April 1942 at Charity Hospital New Orleans.32 His examiner was Dr Alan O. Whipple, who was then the Chair of the American Board of Surgery and the Medical Director of the Memorial Cancer Hospital in New York City. Dr Clark described Dr Whipple as “very considerate, and we really had an enjoyable time”.33 He was certified by the American Board of Surgery in May 1942.34

As described by one of his biographers, “In Jackson, he displayed unusual agility in the operating room, his eye-hand coordination exquisite, and his speed unrivaled. Unlike most surgeons, Clark had the training of an internist with the intellectual curiosity that transcended tumor removal and tissue repair”.2 However, Dr Claude Dixon, one of his Mayo Clinic surgical mentors, expressed some concern about the ‘super dedication’ to his work and his prodigious surgical workload (Fig. 3a). In a handwritten letter on 28 May 1942, Dr Claude Dixon wrote: “Now, Clark, you’re too young and inexperienced yet to understand why you can’t always keep on the go 24 hours a day. For God’s sake, start now to take it easier ... You owe something to your family and yourself. Just quit running all over Hell’s half-acre seeing cases. You can’t operate on everyone. Confine your work to your own hospital only. I don’t give a damm what anyone tells you. I know I am right, and I do want to tell you before you “crack-up”… Remember me to Mrs. Clark. This advice also applies to her. You both know how interested I am in your welfare … As ever, C.F. Dixon”.35

Surgical Practice in the Army Air Force (1942–1946)

One Sunday morning on 7 December 1941, Dr Clark heard on the radio that Pearl Harbor, Hawaii, had been attacked. In his words, “I asked to be relieved of my responsibilities in Jackson and went to the Army Air ForceFootnote 9 (AAF) Medical Department”.1 Although he volunteered to go into the military, he was viewed as an ‘essential’ physician in his local area, and the draft board had some hesitancy about his leaving a busy surgical practice.37 Dr Clark persisted and was finally commissioned into the AAF with the rank of Captain in August 1942 and was assigned as Chief of Surgical Services at the Station Hospital at Seymour Johnson Field, North CarolinaFootnote 10 (Fig. 5a and electronic supplementary Fig. S4).1,38 This assignment allowed him to continue his surgical load along with the senior administrative leadership of 30 surgeons at this 1000-bed hospital, one of the largest in the Carolinas.

Fig. 5
figure 5

Dr Clark was commissioned into the Army Air Corp (July 1942). (a) He was first appointed as a Captain, then as a Major (October 1943), and (b) then promoted to Lt. Colonel in October 1945 until July 1946. (c) Dr Clark was Editor of the Air Surgeon’s Bulletin during the war, which was distributed to all physicians in the Army Air Force.46 (Photos courtesy of McGovern Historical Library, Texas Medical Center. Series I. Box 3; file 6. Used with permission)

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Dr Clark proved to be a resourceful and innovative surgical leader in the AAF, including many clinical research contributions. He published the results of new technologies and refined surgical procedures. Here are three examples. First, he conducted research into the common problem of testicular varicoceles, a condition that left many recruits unfit for flight school. He developed a surgical procedure for this condition that was published in February 1944 in the journal Surgery, Gynecology and Obstetrics, one of the most influential surgical publications (now published as the Journal of the American College of Surgeons).39 Second, he wrote about the prevention and management of frostbite, caused by the extreme cold and wind blast in AAF bombers flying at high altitudes.40,41 Third, Dr Clark made contributions in the surgical management of pilonidal cysts (another common ailment among airmen sitting for prolonged periods while flying).42

A 3-month period in 1943 was a fateful time in his career, when Major Clark enrolled in the School of Aviation Medicine at Randolph Field Texas, to learn more advanced skills of a flight surgeon. During this time, he developed relationships with key individuals who would later join Dr Clark on the MD Anderson Hospital faculty. Most notably, he developed friendships with Edgar White, from Louisville, KY. Dr Edgar WhiteFootnote 11 was Chief of Surgical Training at the School of Aviation Medicine, Randolph Field, from 1943 to 1945. The two of them forged a close friendship with one of their instructors, Dr Clifton Howe (see footnote 11) a Canadian and a specialist in tropical medicine at the time. The three even played on the same baseball team at Randolph Field. At one point, Dr Clark asked them “If I do something after the war, if I can build a clinic somewhere, would you be interested in joining me? Well, they both said, “we think we would”.1

After a year in the AAF, Captain Clark was promoted to the rank of Major (October 1943). His surgical leadership was recognized by being appointed, in March 1944, as a member of the Surgical Advisory Board to the Air Surgeon, and also as one of five Consulting Surgeons for the entire AAF Medical Services, assigned to the AAF bases in 21 Eastern states “for consultation and advice on surgical problems within his command”.43 However, he was worried that he was going to wind up in Washington, “shuffling a lot of paper”,1 so he requested to be transferred to Wright Patterson FieldFootnote 12 in Dayton, OH as Chief of the Experimental Surgical Unit, where he supervised surgical experiments and clinical application of surgical problems in aviation medicine. As he described this opportunity, “It made a good place to start a surgical research program, and since Dayton was centrally located, it would be a good place for my consulting work. I could easily travel to any of the 75 Air Force hospitals in the country that had need of surgical consultation”.1 Starting in May 1944, he directed programs in surgical education and gave monthly conferences with Dr Alfred Shands to many of the 10,000 board-qualified specialists; he also initiated the Air Surgeons’ Bulletin that was distributed to all Air Force physicians (Fig. 5c).1,9,45,46 Dr Clark developed an active animal surgery laboratory with experimental programs that included experiments involving frostbite, arterial anastomosis, skin grafting, and effects of various chemotherapy and biological agents on tissue growth and wound repair.47,48 He performed significant trauma research on vascular and orthopedic injuries resulting from parachuting, where out of every eight men who parachuted from an airplane at that time, two were killed and 4 were injured. He wrote: “We worked on this [parachute injuries] and on the trauma associated with the forces resulting from crashes. We worked on ways of anastomosing blood vessels and other things to keep from losing legs. For the first time in the history of wars … there was a real opportunity to save legs and arms and lives”.1 He published his results in the Annals of Surgery, covering surgical problems in aviation medicine and describing casualties due to aircraft accidents, enemy gunfire, parachute injuries, frostbite at high altitude, and the types of surgical treatment for these types of trauma.40

His final assignment in the AAF was at Randolph Field Air BaseFootnote 13 in San Antonio, TX, as Director of a newly formed Department of Surgery at the 250-bed Station Hospital, and as Director of Experimental Animal Surgery at the AAF School of Aviation Medicine;Footnote 14 as Surgical Consultant, for the Central District, USA; and as a member of the Surgical Advisory Board to the Air Surgeon.49,50,51,–52 From December 1944 until his discharge in July 1946, he frequently performed major surgery on enlisted military and their dependents, who presented with the full range of general surgery pathology (e.g. major trauma, hernias, gallstones, appendicitis, varicose veins, gynecology, and head and neck pathology).53 He also conducted research in surgery at the School of Aviation Medicine and was responsible for the supervision of animal and patient research projects, the instruction of medical officers and enlisted personnel in surgical technique and perioperative management of aviation medicine, and directed hospital care and surgical service for all Randolph Field personnel.54 He was promoted once again to the rank of Lieutenant Colonel in October 1945 (Fig. 5b). He made stops at military bases all over the country as a primary consultant in general surgery to the Surgeon General, oftentimes piloting a B-47 plane.55 During this time, he published a major article about surgical problems in aviation medicine in the Annals of Surgery,40 and edited a two-part, 357-page surgical textbook for military surgeons titled “The History of Surgery, Army Air Force Medical Department, World War II (Fig. 6)”.56,57 Volume I of the textbook included details on organizing an AAF Surgical Service, treatment of shock, aircraft accidents, frostbite, enemy gunfire, burns, and elective surgery for hernias, varicoceles, varicose veins, pilonidal cysts, and vascular injuries (including illustrations on surgical technique).55 Volume II of the surgical textbook discussed surgical research, including organizing both clinical and experimental surgical research programs, as well as extensive tables and charts on surgical practices and procedures employed by the AAF Medical Department, and statistics on operations at the major AAF hospitals, including studies of hernia repairs, appendicitis, and frostbite.56 For his significant contributions to the AAF Medical Service, he received the Air Force Legion of Merit in May 1947.1,58;Footnote 15

Fig. 6
figure 6

Lt Col R. Lee Clark’s last major project in the Army Air Force was editing a 357-page, two-volume surgical textbook for surgeons at Air Force Hospitals: (a) “The History of Surgery, Army Air Force Medical Department, World War II“. Chapters included details of the surgical technique for (b) hernia repairs, (c) pilonidal cysts, and (d) vascular anastomosis.55,56 (Photos courtesy of McGovern Historical Library, Texas Medical Center. Used with permission)

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Dr Clark’s leadership abilities were described in a letter from his supervisor, Dr Alfred Shands:Footnote 16 “Those of us in the Air Surgeon’s Office who were acquainted with Col. Clark, considered him one of exceptional ability in the field of research and teaching. He definitely has a keen analytical mind, which is well-adapted for investigation. His ability as a surgeon has always been considered excellent. In addition to his professional qualifications, he has an extremely nice personality, gets along easily with his associates and is endowed with administrative ability”.59

As the war in Europe and Asia was winding down in 1945, Dr Clark began to explore surgery positions after leaving the AAF. Once again, his mentor, Dr Claude Dixon, played a pivotal role in guiding his career. The two exchanged numerous letters about job opportunities in a ‘teaching hospital’. At the same time, the Acting Director of MD Anderson Hospital, Dr Ernst Bertner, had been appointed as the first President of the Texas Medical Center, and informed the University of Texas (UT) Board of Regents that they needed to find his replacement.

On 25 December 1945, at a Christmas party in Rochester, MN, at the home of Dr Manford Comfort,Footnote 17 Dr Dixon urged the Chair of the UT Board of Regents, Judge Dudley Woodward, to contact Lt Colonel Clark at Randolph Field, San Antonio, about the Director position.1 The following day, Dr Dixon wrote letters to Dr Clark and Mr. E.B. Stroud, a Dallas lawyer who was Dr Comfort’s brother-in-law and a personal friend of Judge Woodward.60 Dr Clark then wrote immediately to Judge Woodward who, in turn, arranged for Dr Clark to drive to Austin, TX, to interview with the Acting UT President, Dr Theophilus Painter, on 15 January 1946.61

Dr Clark then met with the UT Board of Regents on 22 February 1946 in the first of three interviews over 5 months. On 26 February 1946, he formally applied for the position, writing out a detailed proposal of his vision for MD Anderson Hospital on AAF stationary, along with a proposed organizational chart of the MD Anderson Hospital (Fig. 7 and electronic supplementary Fig. S5).62,63;Footnote 18 After a rather turbulent and vacillating recruitment process with competitive candidates, Dr Clark received a unanimous vote to become the first permanent Director and Surgeon-in-Chief at the UT Board of Regents meeting on 12 July 1946.64;Footnote 19 And so, Randolph Lee Clark Jr then began the most productive phase of his career as the first permanent Director and Surgeon-in-Chief of MD Anderson Hospital for Cancer Research (as it was named in 1946).

Fig. 7
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(a) Formal letter from Dr Clark applying for the position of Director of the UT MD Anderson Hospital for Cancer Research, 26 February 1946.61 (b) Organizational diagram from Dr Clark describing the integration of clinical, research, and educational missions. (Courtesy of McGovern Historical Library, Texas Medical Center. Series X. Box 27; file 7; and Series II. Box 10; file 8. Used with permission)

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